Pelvic Lymph Node Dissection

Considered to be the “final check” to determine if cancer has spread, this procedure can be completed through normal open surgery but more often is conducted using a fiber optic probe that is inserted through a small incision in your abdomen.

All of these diagnostic tests are tools to determine whether there is a possibility of cancer present in the prostate and if so, just how invasive it may be.

However, there is only one way certain method to determine the presence of cancer cells and that is by examining the tissue itself.

Based on the findings of the tests we have discussed, if a physician determines that there may be cancer cells he will recommend a biopsy. It is done by a urologist and the procedure is normally done right in his office. Here is where the ultrasound we discussed previously comes into play.

Using a transrectal ultrasound (TRUS), the doctor will image the prostate by using sound waves by inserting an instrument into your rectum. This allows the doctor to “image” the prostate. He will use biopsy needles that are hollow into any area of the prostate that looks or feels suspicious. Small bits of tissue are extracted through the needle. You may feel a stinging sensation.

Depending on the reasons for the biopsy, the doctor may take samples randomly. For instance, if the biopsy is conducted due to elevated PSA instead of a suspected abnormality in the prostate gland, as many as a half dozen or more samples may be taken. This is considered a “pattern biopsy” and is done to help determine the size and invasiveness of any cancer. Even though you may have multiple samples, a biopsy can still miss some cancers.
Once the biopsy is complete, the tissue samples are taken to a pathologist to determine the presence of cancer cells.

Normal prostate cells are usually uniform in size and are neatly patterned when viewed under a microscope. They appear similar to one another in an orderly manner.
Abnormal cells change their appearance and are not well defined. They will usually appear as misshapen and irregular.

As they deteriorate, a tumor can appear. Tumors can be benign (non-cancerous) or malignant (cancerous).

If the pathologist determines the presence of prostate cancer, he will “grade” each of the tissue samples. This will determine how advanced beyond normal the cancerous tissue has developed. This grading system gives the physician a good idea as to how the tumor is behaving. Tumors with a low grade are most likely to be slow-growing. Tumors with a high grade are more apt to spread aggressively or may have already spread outside of the prostate. If the latter is true, it is said to be “metastasized.”

The actual grading system most widely used by pathologists is the Gleason Grading System, developed in 1977 by Pathologist Donald Gleason. You will find the Gleason Scores in numerous places on and off the internet as it is a standard method, but we have provided them for you here.